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Simplified, standardized methods to assess the accuracy of clinical cancer staging

Wu, Dolly Y. and Spangler, Ann E. and Vo, Dat T. and de Hoyos, Alberto and Seiler, Stephen J. (2020) Simplified, standardized methods to assess the accuracy of clinical cancer staging. Cancer Treatment and Research Communications, 25 . Art. No. 100253. ISSN 2468-2942.

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Background. Hospitals lack intuitive methods to monitor their accuracy of clinical cancer staging, which is critical to treatment planning, prognosis, refinements, and registering quality data. Methods. We introduce a tabulation framework to compare clinical staging with the reference-standard pathological staging, and quantify systematic errors. As an example, we analyzed 9,644 2016 U.S. National Cancer Institute SEER surgically-treated non-small cell lung cancer (NSCLC) cases, and computed concordance with different denominators to compare with incompatible past results. Results. The concordance for clinical versus pathological lymph node N-stage is very good, 83.4 ± 1.0%, but the tumor length-location T-stage is only 58.1 ± 0.9%. There are intuitive insights to the causes of discordance. Approximately 29% of the cases are pathological T-stage greater than clinical T-stage, and 12% lower than the clinical T-stage, which is due partly to the fact that surgically-treated NSCLC are typically lower-stage cancer cases, which results in a bounded higher probability for pathological upstaging. Individual T-stage categories Tis, T1a, T1b, T2a, T2b, T3, T4 invariant percent-concordances are 85.2 ± 9.7 + 10.3%; 72.7 ± 1.6 + 11.3%; 46.6 ± 1.8 + 10.9%; 54.6 ± 1.6 – 20.5%; 41.6 ± 3.3 – 0.1%; 54.7 ± 2.8 – 24.1%; 55.2 ± 4.7 + 2.6%, respectively. Each percent-concordance is referenced to an averaged number of pathological and clinical cases. The first error number quantifies statistical fluctuations; the second quantifies clinical and pathological staging biases. Lastly, comparison of over and under staging versus clinical characteristics provides further insights. Conclusions. Clinical NSCLC staging accuracy and concordance with pathological values can improve. As a first step, the framework enables standardizing comparing staging results and detecting possible problem areas. Cancer hospitals and registries can implement the efficient framework to monitor staging accuracy.

Item Type:Article
Related URLs:
URLURL TypeDescription
Spangler, Ann E.0000-0002-0982-1855
Vo, Dat T.0000-0001-9088-7132
Seiler, Stephen J.0000-0002-7501-9844
Additional Information:© 2020 The Author(s). Published by Elsevier Under a Creative Commons license Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) Available online 1 December 2020. We especially thank the U.S. National Cancer Institute's SEER Program; UT Southwestern Medical Center Cancer Registry; UTSW Thoracic Surgery Database (Phillip Escarsega); Ana Barragan Montero (PhD), Yasmeen Butt (MD), H. Michael Crowson (PhD), Fernando Kay (MD), Mia Lv (PhD), Ayobami Odu (MBBS), Kenneth Westover (MD,PhD). Credit author statement. Dolly Y. Wu: Conceptualization, Resources, Methodology, Data curation, Software, Validation, Formal analysis, Investigation, Visualization, Project administration, Funding acquisition, Writing - original draft, Writing - review & edit Ann E. Spangler: Conceptualization, Resources, Writing - review & edit, Investigation Dat T. Vo: Conceptualization, Resources, Writing - review & edit, Methodology, Investigation, Funding acquisition Alberto de Hoyos: Conceptualization, Resources, Writing - review & edit Stephen J. Seiler: Conceptualization, Resources, Writing - review & edit, Project administration, Funding acquisition Conflict of interest and support. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The retrospective patient review study protocol was approved by the UTSW Institutional Review Board (STU042018–003, with waived informed consent).
Funding AgencyGrant Number
National Cancer InstituteUNSPECIFIED
Subject Keywords:Cancer staging; Accuracy; Monitoring methods; Quality; Lung cancer; Registry data; SEER
Record Number:CaltechAUTHORS:20201224-085808138
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Official Citation:Dolly Y. Wu, Ann E. Spangler, Dat T. Vo, Alberto de Hoyos, Stephen J. Seiler, Simplified, standardized methods to assess the accuracy of clinical cancer staging, Cancer Treatment and Research Communications, Volume 25, 2020, 100253, ISSN 2468-2942,
Usage Policy:No commercial reproduction, distribution, display or performance rights in this work are provided.
ID Code:107281
Deposited By: George Porter
Deposited On:04 Jan 2021 16:15
Last Modified:04 Jan 2021 16:15

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